Anesthesia Coding Alert

If you think Swan-Ganz, A-line and central venous catheter (CVP) placements are always included in the global anesthesia fee, think again. Follow these guidelines to code your anesthesiologist's line placements as separate services and boost your bottom line. Step 1: Match the Right Codes With CVP, A-Line and Swan-Ganz Services The correct line placement codes depend on the type of line used and other factors. For example, to choose the correct codes for lines placed to monitor central venous pressure, you have to know two things: the patient's age and the approach used to place the line. Your options include:

36488* Placement of central venous catheter (subclavian, jugular, or other vein) (e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy); percutaneous, age 2 years or under
36489* percutaneous, over age 2
36490* cutdown, age 2 years or under
36491* cutdown, over age 2. To code arterial lines (also called A-lines), report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous). These lines measure arterial blood pressure and provide easy access for drawing blood to study what gases are present, says Kelly Dennis, CPC, EFPM, owner of the anesthesia consulting firm Perfect Office Solutions in Leesburg, Fla. (Code 36625, cutdown, represents A-line insertion when the physician uses a cutdown approach, but Dennis says this code is rarely used.)

As for Swan-Ganz lines, you will need to report the surgical service code CPT 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes). Anesthesiologists use Swan-Ganz catheters to obtain diagnostic information such as cardiac output, left ventricular filling pressure, and pulmonary and systemic vascular resistance, and to continually monitor heart function in critically ill patients.
Invasive lines are coded as flat-fee or surgery services, which is why you report these codes instead of anesthesia codes. You also do not report anesthesia time, says Cindy Smith, CPC, an anesthesia coder with Professional Healthcare Billing Services in Charleston, W.V. If an invasive line is placed after the patient is anesthetized, however, you don't subtract the time spent placing the line from the total anesthesia time for the procedure you just add it as a separate service in addition to the procedure's anesthesia and time units. Some carriers' policies may vary on how to code a line placed after the physician administers the anesthesia, so check with your carrier when deciding how you should report the service.

Multiple-surgery rules do not apply to these types of line insertions, so the anesthesiologist should receive full reimbursement for each line that is placed and documented. This also means that you do not append modifier -51 (Multiple procedures) when coding for multiple lines.
 
In contrast to these invasive lines, Dennis says the standard [...]